Medical Jurisprudence

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Medical Jurisprudence

• Dr. Nagesh K.R.
• Associate Professor
• Dept of Forensic Medicine
• FMMC, Mangalore

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• Medical Jurisprudence
• Juris Law Prudentia Knowledge
• Application of knowledge of law in relation to
• practice of medicine.
• Two parts
• Ethical aspects of medical practice
• Legal aspects of medical practice

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Medical ethics

• Ethics derived from Greek term ethikos, which
  means
• Rules of conduct that govern natural
  disposition in human beings.
• Central Council of Homeopathy, India Homoeopathic
  Practitioners (Professional Conduct, Etiquette
  and Code of Ethics) Regulations, 1982.
• The Indian Medical Council Act, 1956
  (Professional Conduct, Ethics) regulations.

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• These Acts describe the following points
• Code of medical ethics
• Duties of physicians
• - To their patients
• - In consultation
• - To colleagues
• - To public paramedical profession
• Professional misconduct

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Code of Medical ethics
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1. Declaration

• Hippocratic Code
• The Declaration of Geneva (1948)
• I solemnly pledge myself to consecrate my life to
  the service of humanity.
• Even under threat, I will not use my medical
  knowledge contrary to the laws of humanity.
• I will maintain the utmost respect for human
  life.
• I will not permit consideration of religion,
  nationality, race, political beliefs or social
  standing to intervene between my duty and my
  patient.
• I will practice my profession with conscience and
  dignity.
• The health of my patient shall be my first
  consideration.
• I will respect the secrets which are confided to
  me.
• I will give to my teachers the respect and
  gratitude which is their due.
• I will maintain by all means in my power, the
  honour and noble traditions of medical
  profession.
• My colleagues will be my brothers and sisters.
• I make these promises solemnly, freely and upon
  my honour.

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2. Duties responsibilities of physician in
general

• Character of the physician good medical
  practice
• Uphold dignity honour of his profession.
• Render service to humanity
• (financial gain is not primary objective).
• Practice the system of medicine only in which
  they are qualified.
• For the advancement of his profession
  Membership in Medical Associations Societies.
• Should try continuously to improve medical
  knowledge skills CMEs (min of 30 hrs every 5
  yrs).

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3. Maintenance of medical records

• Shall maintain the medical records pertaining to
  his / her inpatients for a period of 3 yrs.
• If requested, medical records should be issued
  within 72 hrs (patients / authorized attendant /
  legal authorities).
• Shall maintain a Register of Medical Certificates
  giving full details of certificates issued. When
  issuing a medical certificate, always enter the
  identification marks of the patient and keep a
  copy of the certificate.
• Efforts shall be made to computerize medical
  reports for quick retrieval.

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4. Display of registration numbers

• Shall display the registration number Clinic,
  prescriptions, certificates, money receipts given
  to his patients.
• Shall display as suffix to their names only
  recognized medical degrees / certificates /
  diplomas / memberships / honors which confer
  professional knowledge or recognizes any
  exemplary qualification / achievements.

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• 5. Use of Generic names of drugs
• Shall ensure that there is a rational
  prescription and use of drugs.
• 6. Highest quality assurance in patient care
• Should aid in safeguarding the profession.
• Shall not employ any attendant who is neither
  registered nor enlisted under the Medical acts,
  
• shall not permit such persons to attend, treat
  or perform operations upon patients wherever
  professional discretion or skill is required.
• 7. Exposure of Unethical Conduct
• Should expose, without fear or favour,
  incompetent or corrupt, dishonest or unethical
  conduct on the part of members of the
  profession.

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• 8. Payment of Professional Services
• Should announce his fees before rendering service
  and not after the operation or treatment is under
  way.
• It is unethical to enter into a contract of no
  cure no payment.
• Physician rendering service on behalf of the
  state shall refrain from anticipating or
  accepting any consideration.
• 9. Evasion of Legal Restrictions
• Shall observe the laws of the country in
  regulating the practice of medicine.

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Duties towards patients

• Obligations to the sick
• Right to choose patient
• Emergency Should be attended
• Patience, delicacy secrecy
• Prognosis
• Should neither exaggerate nor minimize the
  gravity of a patients condition.
• Should not neglect the patient

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Duties of physician in consultation
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Duties of physician in consultation

• Punctuality in consultation
• For the patients benefit.
• Unnecessary consultation should be avoided.
• Consultant should not charge extra fee.
• Statements treatment after consultation
• Should take place in front of patient their
  relatives.
• Differences of opinion should not be divulged
  unnecessarily.
• Open to patient to seek further advice.
• Patients referred to specialists

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Duties towards their colleagues

• Render gratuitous service to all physicians and
  their immediate family dependants.
• Should not criticise the treatment decisions of
  other physicians.
• Should not take charge for consultation sent by
  another physician.
• Appointment of substitute during temporary
  absence from medical practice.
• Avoid visiting another physicians case.

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Duties of physician to the public paramedicals

• Public and Community Health
• Enlighten the public on prevention of epidemic
  and communicable diseases.
• Notify the public health authorities of every
  case of communicable disease under his care.
• In epidemics, should not abandon from his duty
  for fear of contracting the disease himself.
• Pharmacists/ Nurses
• Recognize and promote the practice of different
  paramedical services as professions and should
  seek their cooperation wherever required.

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Professional misconduct /Infamous conduct
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Professional misconduct

• 1. Advertisement
• Using patients as subject of any form or manner
  of advertising or publicity through any mode.
• Should not advertise any drug/ surgical
  appliances.
• Printing of self photograph / any such material
  of publicity in the letter head / on sign board
  of the consulting room.
• Permitted to make a formal announcement in press
  
• On starting practice.
• On change of type of practice.
• On changing address.
• On temporary absence from duty resuming to
  duty.

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Professional misconduct

• 2. Association
• Drug companies-gifts,
• Laboratories-commission,
• Colleagues-cut back,
• Employer-fee splitting.
• 3. Alcoholism.

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Professional misconduct contd

• 4. Adultery.
• 5. Abortion Surgeries
• Conducted by self without sufficient training
  and qualification.
• Helping some other who is not qualified.

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Professional misconduct contd

• 6. Human rights violation by inflict mental or
  physical trauma or concealment of torture.
• 7. Conviction by Court for moral turpitude.
• 8. Issuing false / improper medical certificates.
  
• 9. Contravention of Drugs Act Prescribing or
  dispensing secret remedies.
• 10. Breach of patient confidence without any
  solid reason to do so.

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Professional misconduct contd

• 11. Not taking proper and appropriate written
  consent for operation or whenever the procedure
  may endanger his/her life.
• 12. Claiming to be specialist without recognized
  qualification or experience.
• 13. Violation of existing ICMR guidelines while
  conducting medical research.
• 14. Practicing euthanasia.
• 15. Pre-natal sex determination.

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Professional misconduct contd

• 16. Found absent on more than two occasions
  during
• - Inspection by district health authority.
• 17. Found absent on more than two occasions from
  the medical college/institution where they are
  posted.

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Professional secrecy
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Professional secrecy

• The secrets confided to a doctor by the patient
  during the course of his professional service.
• Should not divulge patients information even to
  
• Near relatives (except minors/ mentally
  deficient).
• Spouse of the patient.
• Public/ statutory body (insurance companies,
  Govt. bodies).
• Police in under-trial prisoner (except convicted
  person - Sec. 53, 54 Cr.P.C.) .
• Employer of factory about their employees.
• Publishing in media/ journals.

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Privileged communication
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Privileged communication

• Communication made by a doctor to a proper
  authority who has corresponding legal, social
  moral duties to the public.
• Employee / employer
• Communicable disorders
• Driver/ pilot/ captain of ship suffering from
  epilepsy, high BP, drug addiction, alcoholism,
  colour blindness, etc.
• Patients interest
• Dangerous psychological conditions, suicidal
  tendencies.
• In veneral diseases
• Before marriage
• After marriage

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Privileged communication contd

• Infectious diseases
• Notify to public health authorities
• In criminal cases
• Should inform the authorities
• In the court of law
• Should divulge (can be written form)
• In insurance cases
• Should divulge (if appointed by the insurance
  company)

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Thank you